Tag Archives: Healthinsurance.org

No doubt you have seen or read stories about innocent Americans who have become casualties of Obamacare. The law that was supposed to help middle-class families is now asking them to pay unreasonable premiums and sky-high deductibles. In many cases, they had perfectly good coverage that has been cancelled because it didn’t meet the Affordable Care Act’s (ACA’s) “standards.”

Knowing this, when I read the horror stories, I can’t help but wonder: have the folks who are quoted checked prices on their Exchange? Do they know whether they are eligible for government subsidies? How many didn’t even try to find out because they just don’t like the ACA? Who are these people who step forward to identify themselves victims of the trainwreck called Obmacare? Where did they come from? How did the reporters who wrote the stories find them?

Finally, and perhaps most importantly, are journalists fact checking their tales? How many are just writing down whatever their sources tell them?

A Young Mother Suffering From MS Searches For Insurance

“Whitney Johnson, an Arlington 26-year-old with multiple sclerosis, can’t afford to go without health insurance. Her life depends on it.

She gave birth to her first child Sept. 2 after undergoing a series of rigorous steroid treatments, surgeries and a plasma exchange that saved her life. She pays $325 a month for an individual insurance plan – a drop in the bucket compared with the cost of her plasma protein replacement therapy, which runs $40,000 a pop. She undergoes treatment every five weeks.

But now, with the Affordable Care Act in full swing, Johnson’s insurance is under threat.. . .

Recently, the story explains, Johnson’s insurer sent her a letter saying that because her policy “does not comply with Obamacare” it will be cancelled Jan. 1, 2014. Initially she hoped that she might shift to her husband’s employer-based health plan For $325 a month, it covers him and their son. But it turns out that if Whitney were added the policy, their premium would triple.

Meanwhile, she “has been unable to access the federal health exchange website” the newspaper reports, “which has been hampered by technical problems.”

This is when I knew that there was something very wrong with Johnson’s story.

$1000 a Month To Insure a 26-Year- Old ???

Anyone who knows anything about Obamacare would realize that under the ACA, no 26-year-old would be asked to pay $12,000 a year – even if she had MS. Obamacare does not let insurers charge more because a customer suffers from a pre-existing condition. This rule applies to all new policies, whether they are sold inside or outside the exchanges.

Originally, conservatives claimed that Obamacare would be too expensive. Americans who tried to buy insurance in the exchanges would experience “Sticker Shock!” Now that states have begun to announce premiums, it’s becoming apparent that this isn’t true.

So conservatives have regrouped. In an about-face, they are acknowledging that some plans offered in the exchanges may be affordable, but this, they say, is because insurers are limiting their networks to providers who will accept lower fees.

When you’re fibbing, it’s easy to begin contradicting yourself. The truth is that people who have not been able to afford insurance in the past are far more interested in price than they are in the size of the network.

Both insurers and “employers are sending a message that they are no longer willing to pay for hospitals that charge higher rates for routine services to cover costs of their teaching and research missions,” Kerr adds.

In March, the Obama administration proposed revising the rules governing insurance marketplaces or “exchanges” where small business owners will be able to pool their buying power, and purchase affordable, high quality insurance for their employees. The change to the rules is small, and it is temporary.

Now consider the proposed change. Originally, the Affordable Care Act called for opening SHOP exchanges to employees in 2014. First, the employer would choose a tier of insurance. (Bronze, Silver, Gold or Platinum tiers will pay 60 percent to 90 percent of an average group’s covered benefits, with any individual’s out-of-pocket spending capped at roughly $6,000.) Employees would then pick plans from that tier.

But Washington had assumed that states would be eager to help their small businesses by setting up exchanges. Today, only 16 states and the District of Columbia have begun. Now the administration realizes it will need more time to set up the IT that millions of employees will need to navigate exchanges in 34 states.

HHS still plans to open the exchanges in 2014, but only to employers. They will survey the many plans available, and then pick one for their employees. “Employee Choice” will be delayed – but just for one year. And the postponement will apply only to the 34 states that have not set up exchanges. In 2014, the other 16 states and D.C. can (and probably most will) open exchanges to employees.

Laszewski suggests that “a single employer“ will not be able to choose from all of the exchange options.” This is simply not true. Business owners will choose from all plans in the exchange. As for an employer keeping his “existing” coverage – why would he do that? The policies in the exchanges will offer better coverage for less.

Above, the opening of a post that I wrote for HealthInsurance.org. To find out more about why Lawzewski’s is bashing small business Exchanges–and what what Time’s Joe Klein, the Wall Street Journal and Wonkblog’s Sarah Kliff had to say– read the entire post on HIO. You’ll also find out why some of us think that the importance of “consumer choice” may be “way overblown.”

Under the Affordable Care Act, Americans who are not offered “affordable” insurance at work can purchase coverage in the ACA’s health insurance exchanges, where many will be eligible for generous subsidies.

The law defines “affordable” as insurance that costs less than 9.6 percent of income. But the ACA doesn’t specify whether it is referring to individual coverage or family coverage, which is always far more expensive. The wording is ambiguous, an “oversight,” say many legislators.

Now the Internal Revenue Service (IRS) has ruled that the government will look at the cost of coverage for an individual – not a family – when deciding if a plan is “affordable.”

A disaster for Obamacare?

Forbes’ take plays right into the conservative claim that Obamacare is a disaster. “We are now entering the crucial phase of the law’s enactment,” crows blogger Dwight L. Schwab, “and many critics are saying, ‘I told you so.’”

Whoa! Let’s look at Forbes’ argument, and the numbers.

Fear-mongering vs. facts

Forbes observes that, according to the Kaiser Family Foundation’s 2012 survey of employee benefits, on average, workers contribute $951 annually for an individual plan. But those buying family coverage fork over $4,316, “a number well in excess of the 9.5% of earnings for someone making just $35,000 a year.” Yet, under the IRS decision, “only the portion of the contribution attributable to the individual employee” can be “considered for the purpose of determining what is affordable – not the entire contribution.”

Forbes’ contributor Rick Ungar offers an example: If an employee who earns $35,000 and “is the sole breadwinner in the family” pays less than $3,325 annually for his own insurance … “nobody in the family qualifies for participation on the healthcare exchanges and nobody can qualify for the intended government subsidies.” If the employee signs up for a family plan with his employer it would cost “over 12 percent of their annual income … a crushing amount.”

“The result,” Ungar says, “will be millions of spouses and children left to go uninsured.”

Millions uninsured???

Let’s begin with that last sentence. Just how many children would be shut out? Bruce Lesley, president of First Focus, a children’s advocacy group, estimates that 500,000 children could remain uninsured.

But what about the mothers? If 500,000 children might be affected, that means that, at most, 500,000 mothers would be left uninsured. But in most of these cases, parents may well have have two children, sometimes more. Let’s assume that, on average, they have two children. That means 250,000 mothers (half of 500,000) might find themselves uninsured because of the IRS rule. Add those 250,000 mothers to a maximum of 500,000 children, and 750,000 people wind up “going naked” as insurers put it.

Married couples who don’t have children also should be counted. If only one spouse works, and they cannot afford the family plan his employer offers, another adult could be left out. But, these days, few married women under 65 who don’t have children stay at home. We’re still far from “millions.”

Note: The post originally appeared on Healthinsurance.org To find the answer to that question, and why the Forbes Op-ed represents “fear-mongering, pure and simple”, please clickhere. If you like, come back here to comment.